Prostate cancer screening and treatment currently forces men into a series of painful trade-offs: invasive biopsies, overdiagnosis of harmless tumours, and life-altering choices between treatments that can destroy urinary control or sexual function. This project aims to replace that blunt approach with a personalised, risk-stratified pathway for every stage of the disease. The problem is that current screening catches too many slow-growing cancers that will never cause harm, while missing aggressive ones in men from high-risk ethnic or socioeconomic groups. Diagnosis relies on standard MRI scans that not all hospitals can deliver well, and once a cancer is found, men are offered monitoring or treatment options without personalised information about what each choice means for their own future quality of life. If successful, this research would reshape the entire prostate cancer pathway. Community screening would target men at highest risk of aggressive disease. A streamlined MRI protocol—comparing standard scans with faster alternatives and a new technique called Luminal Water Fraction—would make high-quality imaging available across all UK hospitals. A personalised surveillance schedule would let men with stable cancers avoid repeated biopsies. And a web-based decision tool, built from data on how MRI features predict recovery of urinary and sexual function after surgery, would help men choose between treatments based on their own likely outcomes.
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Research question Can a bespoke approach allow us to reduce the harms and maximise the benefits of prostate cancer screening, diagnosis, monitoring and treatment? Background Prostate cancer screening, diagnosis, surveillance and treatment cause significant harm, missing some cancers at a curable stage, 'overdiagnosing' men with indolent disease, using invasive tests to monitor stable cancers, and asking men to choose between treatments with life-changing effects on urinary, sexual and mental health without providing them with adequately personalised information and support. Aims and objectives Design community testing to detect men at highest risk of aggressive cancer Offer good quality MRI across the UK so that cancers are not missed Develop a personalised monitoring schedule to reduce unnecessary invasive procedures and improve mental health Develop a personalised web-based tool to support men choosing between monitoring and treatments with different side effect profiles Methods Through a combination of leveraging existing funded work, and new studies, I will: Evaluate the response to screening across different ethnic and socio-economic groups and assess how a modified approach could include those at highest risk of prostate cancer (Re-Imagine Screening, LiMiT) Compare standard multi-parametric MRI with bi-parametric MRI and Luminal Water Fraction (LWF) to establish the most efficient approach to allow all hospitals to offer high quality MRI for prostate cancer diagnosis (PiQUAL, PRIME, Climate) Assess the impact of an MRI-led, personalised surveillance strategy (PRECISE, REASSURE), and model this in different international cohorts (PRIAS, Europe; National Institute for Health, USA) to determine a dynamic model which allows detection of cancer progression whilst allowing men with stable cancer to avoid invasive biopsies during surveillance Ascertain the relationship between MRI features, urinary and sexual health recovery and hospital episode statistics data (HES) in men after localised prostate cancer treatment (TrueNTH Post Surgery, TrueNorth Global, BeSpoke Recovery) Develop a personalised decision support tool, based on urinary and sexual health at baseline, along with MRI phenotype of the cancer and surrounding structures, to help men identify the likelihood of cancer control and sexual and urinary health after different treatments for localised prostate cancer Timelines for delivery From analysis of Re-Imagine Prostate Cancer Screening I will deliver a framework for an improved community screening approach in year 1, and will assess this in LimiT in years 2 and 3. By the end of year two I will have assessed the relationship between MRI phenotype and recovery of urinary and sexual function after prostate cancer surgery. In year 3 I will develop a model for a personalised recovery prediction based on baseline questionnaire and MRI data, and this will be tested in year 4. In year 5 I will make the web-based personalised recovery prediction and active surveillance tools available for use by men and clinicians. Anticipated impact and dissemination A bespoke prostate cancer approach would see community screening to detect men at highest risk of prostate cancer, ensure all men get the right prostate MRI scan first time, see less unnecessary invasive testing, and more support for men to make a personalised treatment choice.
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